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. 2023 Feb 8;76(3):e450-e459.
doi: 10.1093/cid/ciac388.

Comparison of Influenza and Coronavirus Disease 2019-Associated Hospitalizations Among Children Younger Than 18 Years Old in the United States: FluSurv-NET (October-April 2017-2021) and COVID-NET (October 2020-September 2021)

Miranda J Delahoy  1   2   3 , Dawud Ujamaa  1   2 , Christopher A Taylor  1 , Charisse Cummings  1   2 , Onika Anglin  1 , Rachel Holstein  1   2 , Jennifer Milucky  1 , Alissa O'Halloran  1   2 , Kadam Patel  1 , Huong Pham  1 , Michael Whitaker  1 , Arthur Reingold  4   5 , Shua J Chai  4   6 , Nisha B Alden  7 , Breanna Kawasaki  7 , James Meek  8 , Kimberly Yousey-Hindes  8 , Evan J Anderson  9   10   11 , Kyle P Openo  9   10   11 , Andy Weigel  12 , Kenzie Teno  12 , Libby Reeg  13 , Lauren Leegwater  13 , Ruth Lynfield  14 , Melissa McMahon  14 , Susan Ropp  15 , Dominic Rudin  15 , Alison Muse  16 , Nancy Spina  16 , Nancy M Bennett  17 , Kevin Popham  18 , Laurie M Billing  19 , Eli Shiltz  19 , Melissa Sutton  20 , Ann Thomas  20 , William Schaffner  21 , H Keipp Talbot  21 , Melanie T Crossland  22 , Keegan McCaffrey  23 , Aron J Hall  1 , Erin Burns  2 , Meredith McMorrow  1 , Carrie Reed  2 , Fiona P Havers  1 , Shikha Garg  1   2
Affiliations

Comparison of Influenza and Coronavirus Disease 2019-Associated Hospitalizations Among Children Younger Than 18 Years Old in the United States: FluSurv-NET (October-April 2017-2021) and COVID-NET (October 2020-September 2021)

Miranda J Delahoy et al. Clin Infect Dis. .

Abstract

Background: Influenza virus and SARS-CoV-2 are significant causes of respiratory illness in children.

Methods: Influenza- and COVID-19-associated hospitalizations among children <18 years old were analyzed from FluSurv-NET and COVID-NET, 2 population-based surveillance systems with similar catchment areas and methodology. The annual COVID-19-associated hospitalization rate per 100 000 during the ongoing COVID-19 pandemic (1 October 2020-30 September 2021) was compared with influenza-associated hospitalization rates during the 2017-2018 through 2019-2020 influenza seasons. In-hospital outcomes, including intensive care unit (ICU) admission and death, were compared.

Results: Among children <18 years, the COVID-19-associated hospitalization rate (48.2) was higher than influenza-associated hospitalization rates: 2017-2018 (33.5), 2018-2019 (33.8), and 2019-2020 (41.7). The COVID-19-associated hospitalization rate was higher among adolescents 12-17 years old (COVID-19: 59.9; influenza range: 12.2-14.1), but similar or lower among children 5-11 (COVID-19: 25.0; influenza range: 24.3-31.7) and 0-4 (COVID-19: 66.8; influenza range: 70.9-91.5) years old. Among children <18 years, a higher proportion with COVID-19 required ICU admission compared with influenza (26.4% vs 21.6%; P < .01). Pediatric deaths were uncommon during both COVID-19- and influenza-associated hospitalizations (0.7% vs 0.5%; P = .28).

Conclusions: In the setting of extensive mitigation measures during the COVID-19 pandemic, the annual COVID-19-associated hospitalization rate during 2020-2021 was higher among adolescents and similar or lower among children <12 years compared with influenza during the 3 seasons before the COVID-19 pandemic. COVID-19 adds substantially to the existing burden of pediatric hospitalizations and severe outcomes caused by influenza and other respiratory viruses.

Keywords: COVID-19; SARS-CoV-2; children; influenza; surveillance.

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Conflict of interest statement

Potential conflicts of interest. E. J. A. reports grants from Pfizer, Merck, PaxVax, Micron, Sanofi-Pasteur, Janssen, MedImmune, and GlaxoSmithKline (all for clinical trials); personal fees from Sanofi-Pasteur, Pfizer, Medscape, Kentucky Bioprocessing, Inc, Sanofi-Pasteur, and Janssen (all for consulting); and participation on a personal fees for participating on a Data Safety Monitoring Board for Kentucky Bioprocessing, Inc, and Sanofi-Pasteur outside the submitted work. His institution has also received funding from the National Institute of Health to conduct clinical trials of Moderna and Janssen COVID-19 vaccines, unrelated to this work. W. S. reports personal fees from VBI Vaccines, outside the submitted work. N. B. A. reports an Emerging Infections Program cooperative agreement from the Centers for Disease Control and Prevention (CDC) outside the submitted work. K. T. reports grants from CDC/CSTE related to flu surveillance activities unrelated to this work. A. W. reports multiple grants from CDC/CSTE for flu surveillance (eg, Youth in Agriculture, Enhancing Laboratory Capacity) outside the submitted work. R. L. reports a position as an associate editor of Red Book (American Academy of Pediatrics Report of the Committee on Infectious Diseases). L. M. B. reports receipt of Epidemiology and Laboratory Capacity (ELC) and Immunizations and Vaccines for Children (VFC) grant funding from CDC to support vaccine-preventable disease epidemiology staffing, outside the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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